RESUMEN
OBJECTIVE: Asthma is a leading cause of emergency department visits and hospitalizations for children in the United States. As part of a larger study, the purpose of this analysis was to determine which variables were most effective at predicting subsequent pediatric asthma-related emergency department visits and hospitalizations. METHODS: A retrospective, descriptive study was conducted. Subjects consisted of a convenience sample of 298 children admitted to a New England Children's Hospital in 2006 with a primary diagnosis of asthma. Data from two hospital databases were collected for 12 months before and 12 months after the 2006 admission. Basic descriptive statistics were followed by chi-square tests to determine which variables were associated with emergency department visits and hospitalizations. Logistic regression analysis was used to determine which variables were significant predictors of asthma-related emergency department visits and hospitalizations. RESULTS: Sixty-percent of all subjects were male. Ninety subjects experienced a total of 145 emergency department visits and 54 experienced a total of 70 hospitalizations. A previous emergency department visit was a significant predictor of both subsequent emergency department visits and subsequent hospitalizations. Age was also an independent risk factor for subsequent hospitalizations. In this sample, the risk of a hospitalization increased with each year increase in age. CONCLUSION: These findings support the importance of early identification of children with asthma so that appropriate asthma management can be instituted before an emergency department visit occurs. Furthermore, results suggest involving school-age and preadolescent children in the care of their asthma so that they can be equipped and encouraged to self-manage their own asthma.
Asunto(s)
Asma/epidemiología , Servicio de Urgencia en Hospital , Hospitalización , Adolescente , Asma/fisiopatología , Niño , Preescolar , Femenino , Humanos , Masculino , New England/epidemiología , Estudios RetrospectivosRESUMEN
PURPOSE: The purpose of this study was to determine potential associations between obesity as measured by body mass index (BMI) and lipid values in Mexican American (MA) children diagnosed with type 2 diabetes. BACKGROUND: Obesity in children is considered to be an emerging epidemic that is accompanied by an increase in prevalence of type 2 diabetes. Literature shows that there is a direct and strong relationship between abnormal lipid levels and obesity in Caucasian and African American children without type 2 diabetes. However, it was unknown whether Mexican American children diagnosed with type 2 diabetes have abnormal lipid levels. METHOD: A retrospective medical-record review was conducted on paediatric patients who received medical care from a military medical centre in the Southwest region of the United States. A convenience sample of records was used to study the relationship between obesity as measured by BMI and lipid levels in 49 Mexican American children diagnosed with type 2 diabetes. Total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG), and BMI were reviewed. Data were analysed using descriptive and logistic regression statistics. FINDINGS: Ninety percent of the sample was obese and 75% had two or more abnormal lipid values. Abnormal levels of total cholesterol, HDL, and triglycerides were found to be statistically significant. CONCLUSIONS: The main findings indicate that MA children diagnosed with type 2 diabetes had significant associations between obesity as measured by BMI and abnormal total cholesterol, HDL, and triglyceride levels. As the BMI increased, the probability of abnormal total cholesterol and triglyceride levels increased. Similarly, as the BMI increased, the probability of abnormal HDL values increased. Mexican American children in this study had obesity levels similar to those in a study by the National Center for Health Statistics. In this study a step has been taken toward understanding a physiologic marker for cardiovascular disease in children.
Asunto(s)
Diabetes Mellitus Tipo 2/etnología , Hiperlipidemias/etnología , Americanos Mexicanos , Obesidad/etnología , Adolescente , Adulto , Índice de Masa Corporal , Niño , Comorbilidad , Humanos , Lípidos/sangre , Modelos Logísticos , Americanos Mexicanos/estadística & datos numéricos , México/etnología , Estudios Retrospectivos , Sudoeste de Estados Unidos/epidemiologíaRESUMEN
PROBLEM: Depressive symptoms in children have been linked to recurrent problems with depression, school problems, and risky health behaviors. Adolescent girls report depressive symptoms three to four times more frequently than adolescent boys. Few studies, however, have examined gender-related depressive symptoms in younger, school-aged children. METHODS: In the present study, gender differences in depressive symptoms in children ages 10-12 years were explored using the Children's Depression Inventory (CDI) with a convenience sample of 122 suburban middle-class public school fifth and sixth graders. FINDINGS: A distinct pattern of depressive symptom expression was found with girls reporting more internalizing and more negative self-esteem, and boys reporting more externalizing and more school problems. CONCLUSION: These findings suggest that despite similarities on a total depressive symptom score, there are distinct gender differences in depressive symptom expression that are identifiable before adolescence and may be associated with normative development.
Asunto(s)
Depresión/psicología , Niño , Estudios Transversales , Depresión/enfermería , Depresión/prevención & control , Femenino , Humanos , Entrevista Psicológica , Masculino , Medio Oeste de Estados Unidos , Factores SexualesRESUMEN
Victims of domestic violence appeal to the health care system through emergency room visits for injuries related to violent episodes or for proxy care for other complaints. Screening for persons who are at high risk for violence or who are victims of violence has not been performed in emergency rooms when patients present for care, nor have all health care professionals been educated in the ways to ask the questions and assess the patients. The questions for identifying domestic violence victims have not been routinely asked on admission to the emergency department, and documentation of this information is not consistent. The purpose of this survey study was to identify the numbers and characteristics of adult victims of domestic violence who present to the emergency department of an urban community medical center during a 1 0-day period to estimate the extent of the domestic violence in the community served by the acute care facility. Findings demonstrated that emergency department staff had difficulty asking the questions, and the responsibility for the screening was relegated to the triage nurse. Questions were not asked of each adult presenting to the emergency department, and health care staff identified various reasons for their resistance. Although only 12% of persons were screened and only during the hours of 0700 through 1900, positive screens for physical abuse were found in 24.6% (n = 20) of the 81 women screened. Routine screening of all patients and sensitivity to the needs of those who have experienced domestic violence are integral to prevention and safety of those who are victimized. Injury prevention programs can then be instituted in the community with the collaborative efforts of local citizen groups and the health care facility.
Asunto(s)
Violencia Doméstica/estadística & datos numéricos , Centros Médicos Académicos , Adolescente , Adulto , Anciano , Violencia Doméstica/psicología , Servicios Médicos de Urgencia , Femenino , Hospitales Urbanos , Humanos , Masculino , Persona de Mediana Edad , Philadelphia , Estudios Prospectivos , Delitos Sexuales , Encuestas y CuestionariosRESUMEN
Like pain, dyspnea, or difficulty in breathing, is a strong subjective experience of physiologial distress. Using a model developed by DeVito, this study focused on the emotional aspects of the acute experience of dyspnea in patients diagnosed with chronic obstructive pulmonary disease (COPD) on a medical unit and explored nursing activities that eased the intensity of the symptoms. The study was descriptive in design and used a semistructured interview format with four open-ended questions and a numerical self-assessment of dyspnea using the Modified 0-10 Borg Scale (MBS). The sample included 41 hospitalized patients with COPD between the ages of 43 and 89 years who had experienced episodes of acute dyspnea both prior to and during their current inpatient stays. This article provides descriptions of the experience of dyspnea, identifies themes from the participants' responses, notes the patients'perceptions of the efficacy of nursing actions, and extends the use of the MBS to an inpatient population.
Asunto(s)
Disnea/enfermería , Disnea/psicología , Emociones , Enfermería Holística , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Disnea/etiología , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Registered nurses on a medical unit questioned whether current practice adequately met the emotional needs of patients with chronic obstructive pulmonary disease hospitalized for acute dyspnea. The unit's education committee surveyed nursing staff regarding priority nursing activities during dyspneic episodes. After discussion with staff development educators, several registered nurses met with the center's nurse researcher, formed a research team, and designed a descriptive study. Findings of the study gave evidence for clinical practice change and revision of care guidelines.
Asunto(s)
Disnea/enfermería , Educación Continua en Enfermería/organización & administración , Medicina Basada en la Evidencia , Investigación en Evaluación de Enfermería , Personal de Enfermería en Hospital/educación , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Aguda , Actitud del Personal de Salud , Actitud Frente a la Salud , Benchmarking , Competencia Clínica , Difusión de Innovaciones , Disnea/etiología , Disnea/psicología , Medicina Basada en la Evidencia/educación , Medicina Basada en la Evidencia/organización & administración , Necesidades y Demandas de Servicios de Salud , Salud Holística , Humanos , New England , Rol de la Enfermera/psicología , Relaciones Enfermero-Paciente , Evaluación en Enfermería , Investigación en Evaluación de Enfermería/educación , Investigación en Evaluación de Enfermería/organización & administración , Personal de Enfermería en Hospital/psicología , Atención Dirigida al Paciente , Guías de Práctica Clínica como Asunto , Comité de Profesionales/organización & administración , Proyectos de Investigación , Índice de Severidad de la Enfermedad , Encuestas y CuestionariosRESUMEN
AIM: This paper is a report of a secondary data analysis to the hypothesis that a child's resourcefulness moderates the relationships between the primary female caregiver's variables (depressive symptoms and learned resourcefulness) and the child's outcomes (depressive symptoms and adaptive functioning). BACKGROUND: School-aged children between 10 and 12 years of age are at an important stage of development characterized by dramatic biological and psychosocial challenges. Maladaptive functioning and depressive symptoms increase markedly in this stage. To prevent long-term effects of depressive symptoms and impaired adaptive functioning, identifying moderators of the relationship between stress and these mental health indicators is critical. METHODS: A secondary analysis was conducted in 2004 using the data obtained in 2000 from a community-based sample of 122 school students aged 10-12 years and their primary female caregivers in four suburban public schools in Northeastern Ohio. Instruments included the Self-Control Schedule, Beck Depression Inventory, the Children's version of the Self-Control Schedule, the Children's Community Living Skills Scale, and the Children's Depression Inventory. FINDINGS: Children's resourcefulness significantly moderated the relationship between their female caregiver's depressive symptoms and their own adaptive functioning (P<0.01). Children's resourcefulness had a statistically significant impact on depressive symptoms and adaptive functioning (P<0.001). CONCLUSION: The key to reducing depressive symptoms and enhancing adaptive functioning among middle school children is to build their resourcefulness skills, especially in children whose female caregivers are depressed. This is an important role for school nurses.
Asunto(s)
Adaptación Psicológica , Hijo de Padres Discapacitados/psicología , Trastorno Depresivo/psicología , Padres/psicología , Adulto , Niño , Estudios Transversales , Trastorno Depresivo/prevención & control , Femenino , Humanos , Masculino , Solución de Problemas , Escalas de Valoración Psiquiátrica , Estrés Psicológico/psicología , EstudiantesRESUMEN
Within the context of Rosenbaum's theory of learned resourcefulness, this correlational study examined the relationships among family functioning, self-esteem, and resourceful coping in Thai adolescents with asthma. A convenience sample of 132 Thai adolescents (aged 12-17 years) with asthma was recruited from the outpatient asthma clinics of four hospitals in Bangkok. Self-administered questionnaires included an assessment of demographic information and asthma status, the revised Family APGAR, the Rosenberg Self-Esteem Scale, and the Children's Self-Control Scale. Hierarchical multiple regression analysis was used to examine the relationships among variables. Effective family functioning had a significant positive effect on self-esteem (beta = .27, p < .01) and resourceful coping (beta = .30, p < .01), controlling for gender and age. However, self-esteem was not significantly correlated with resourceful coping (beta = .15, p = .08). The findings suggest that nursing interventions should take into account the role of family functioning in promoting self-esteem and resourceful coping in Thai adolescents with asthma. Recommendations for future research include replication of the study with a larger sample of adolescents with asthma and with adolescents with other chronic illnesses.
Asunto(s)
Adaptación Psicológica , Asma , Actitud Frente a la Salud/etnología , Salud de la Familia/etnología , Psicología del Adolescente , Adolescente , Conducta del Adolescente/etnología , Análisis de Varianza , Asma/etnología , Asma/prevención & control , Niño , Análisis Factorial , Femenino , Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud , Humanos , Masculino , Modelos Psicológicos , Rol de la Enfermera , Investigación Metodológica en Enfermería , Servicio Ambulatorio en Hospital , Análisis de Regresión , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , TailandiaRESUMEN
Screening for persons who are victims of domestic violence is not routinely done in emergency departments (EDs) when clients present for care, nor have all health care professionals been educated in ways to ask appropriate questions to assess victimization. Since questions to identify domestic violence are not on admission sheets and documentation is inconsistent, an interdisciplinary team in the ED of an urban medical center conducted a study using five screening questions. Findings revealed inaccurate statistics for domestic violence and significant barriers for staff participation in screening of adult clients. Clinical implications and follow-up educational programs are discussed.